Establish licensing process, contract requirements for PBMs
What changed between versions
Establishes a new Chapter 3957 requiring PBMs to obtain a specific license from the Superintendent of Insurance to solicit plans or provide services in Ohio.
Mandates that PBMs enter written agreements with plan sponsors detailing services, compensation, and renewal/termination terms, and requires annual disclosure of any ownership relationships between the PBM and insurers.
Requires PBMs to maintain detailed books and records of all transactions for ten years and submit annual financial reports to plan sponsors.
Prohibits PBMs from placing drugs on 'maximum allowable cost' lists unless the drug is widely available and rated highly by the FDA, and requires rapid updates to pricing data.
Defines key terms such as 'Pharmacy Benefit Manager,' 'Claims processing services,' and 'Maximum allowable cost' to clarify the scope of the new regulations.
Authorizes the Superintendent of Insurance to investigate PBMs, issue cease-and-desist orders, and impose civil penalties or revoke licenses for violations.
Repeals and renumbers existing sections (3959.111, 3959.20, 3959.22) to integrate them into the new Chapter 3957, updating their section numbers to 3957.25, 3957.26, and 3957.27.
Sets a compliance deadline of July 1, 2027, for the new licensing and contractual requirements to take full effect.
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